The $10,000-a-Day Fine That Has PBMs Sweating

And the PBMs aren't alone. Drug companies, despite loving the idea of someone else getting scrutinized, also quietly prefer to keep their own pricing data under wraps. It's one of those rare moments where pharma and PBMs are on the same side of the barricade, even if they got there for different reasons.

The Other Side: Employers Who Are Tired of Flying Blind

While PBMs are lawyering up, the people who actually pay the bills are cheering.

Businesses and employer groups see the transparency mandate as long overdue. Mark Cuban's pharmacy venture has been vocal about holding middlemen accountable, and the sentiment runs deep among self-insured employers who've spent years writing enormous checks without truly understanding what they're paying for. Taxpayer advocates have piled on too, pointing out that the current system doesn't give employers appropriate access to the most competitive prices in the market.

The math explains why employers are frustrated. The three biggest PBMs control about eight out of every ten prescriptions processed in this country. When you have that kind of market dominance and zero obligation to show your work, the power imbalance is staggering.

The Teeth Behind the Rule

This isn't just a polite suggestion from the government. The transparency requirements come with real consequences.

PBMs that fail to comply face penalties of up to $10,000 per violation, per day. Ryan Temme of Groom Law Group emphasized the scale: failures across multiple business lines could yield "very large numbers very quickly." That's not a parking ticket; that's an existential threat to noncompliant operators.

The rule would require PBMs to provide 30-day pre-contract compensation estimates, followed by semiannual reports of actual figures. Any PBM-linked provider above certain compensation thresholds gets pulled into the disclosure net. Amber Rivers, a Groom principal and former DOL official, noted the rule's broad scope, pointing out that it captures affiliated PBM services across the board.

The Bigger Picture: A Supply Chain Under Siege

The DOL proposal doesn't exist in a vacuum. It's one piece of a broader administration offensive against PBM opacity.

In February 2026, President Trump signed H.R. 7148, the Consolidated Appropriations Act, 2026. The law targets the 160 million Americans with employer-sponsored insurance. Separately, the administration launched TrumpRx.gov, giving patients access to most-favored-nation pricing on 40 popular branded medications.

Starting with plan years beginning on or after January 1, 2029, PBMs will have to pass through 100% of rebates, fees, and discounts to plans and insurers on a quarterly basis. That effectively kills spread pricing, the practice where PBMs charge an employer one price and pay the pharmacy a lower one, pocketing the difference. It's like finding out your real estate agent was buying houses for $300,000 and telling you they cost $350,000.

State legislatures are piling on too. Virginia's S.B. 669, with certain provisions effective July 1, 2027 and delinking provisions effective in 2028, adds its own pass-through and fee-only requirements. A patchwork of state laws is creating a regulatory squeeze from both directions.

So Who Wins?

The legal fight is far from settled. A federal court recently blocked Arkansas's PBM ownership law on constitutional grounds, which gives the industry some reason to believe courts might be sympathetic. PCMA's opposition to the DOL rule could tie things up for months or years.

But the political winds are blowing hard against PBMs. Bipartisan support for transparency, combined with employer frustration and state-level momentum, makes this a difficult tide to fight. Even state attorneys general, including Georgia's Chris Carr, have backed the DOL rule and urged the federal government not to preempt tougher state laws.

PCMA's CEO David Marin has tried to redirect the conversation, highlighting the need for broader supply chain transparency. It's a reasonable point, and it reveals the deeper tension: everyone in the pharmaceutical supply chain wants the spotlight on someone else.

For now, the PBMs are betting that the courts will save them. Employers are betting that sunlight really is the best disinfectant. And somewhere in the middle, the roughly 155 million people covered by employer health plans are just hoping their next prescription doesn't cost as much as a car payment.

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